Provider Demographics
NPI:1710187687
Name:NAGESWARA RAO, AMULYA A (MD)
Entity Type:Individual
Prefix:
First Name:AMULYA
Middle Name:A
Last Name:NAGESWARA RAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMULYA
Other - Middle Name:A
Other - Last Name:NAGESWARARAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:200 FIRST STREET SW
Mailing Address - Street 2:MAYO CLINIC
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55905
Mailing Address - Country:US
Mailing Address - Phone:507-284-2511
Mailing Address - Fax:
Practice Address - Street 1:200 FIRST STREET SW
Practice Address - Street 2:MAYO CLINIC
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55905
Practice Address - Country:US
Practice Address - Phone:507-284-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN49916208000000X, 2080P0207X
DCMD0387782080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN272498200Medicaid
MN272498200Medicaid
MN370004099Medicare PIN